Archive for December 2015

The new Care Certificate that came on stream in April this year identified set of standards that health and social care workers should adhere to in their daily working life. Good.

It was designed with the non-regulated workforce in mind to enable and empower newcomers to the sector. Also good, though the driver was the Francis Report and that highlighted improvement for the practical skills of care staff . . . and nurses, whose role is completely different.

It is aimed at delivering a comprehensive induction, and indeed, is much better than its former model. Again, good.

The outline of learning is supposed to facilitate compassionate, safe and high quality care and support. Well, yes . . .

And all this within three months induction period. You must be joking!

This ‘tool’ for care is cumbersome, taking so much time it’s impractical as a way in to essential knowledge. I know of plenty of cases where providers are still struggling to complete the induction after six months. Surely there’s something wrong!

Critically, does it really give us better carers? No, and what’s more it’s a big turn-off for sector recruitments.

Where previous induction initiatives were centred on essentials (all be it too regulatory focussed) about each area of the industry which enable people to start work within the first six weeks and then build on their knowledge as they worked, now new recruits have a huge block of learning to go through.

Come on, real world dynamics need to apply here!

So, what have we achieved? We have successfully created an industry running round in circles to get as much of the learning tasks completed as possible in the shortest possible time.

What’s more, the process is costing far more that the previous model at a time when the providers have far less to spend. Failure, sadly is inevitable.

Is this a step forward? No, it’s just another hurdle for us the struggle over, where attempts to wholesale avoid risk by the age-old tradition of training on the job actually denies caring.

Caring Times editor, Geoff Hodgson’s blog is always welcome. Recently he recalled the story of his time working as journalist in the goldfields of Western Australia.

The narrative he told is a sad one about an old gold prospector who blew himself up rather than be moved from his ramshackle shanty to be looked after, at the state’s expense, in a care home.

At 80-something he had become “very frail and it was clear he could not continue to live independently,” Geoff recalls.

Moving into a care home is never easy and Geoff rightly observes that it is the loss of independence that is such an “anguished step”.

Good residential care environments indeed do have the potential to give people true independence, options, choices and a more fulfilled lives than they would have if they remained at home.

I agree wholeheartedly with Geoff on this assumption, but only, as he puts it “if they’re allowed to”.

We have possibly the most regulated industry in the world and for most smaller providers, all they’re trying to do is make a legitimate living at providing good care.

I genuinely fear that our caring sector is turning into an industry focused on compliance and regulation, rather than care. These two essential of staying in business are huge money-makers in their own right and we can’t deny the expertise being offered by these relatively new players in caring.

Ironically, I envisage a continuing growth in regulatory framework, while the industry it serves becomes progressively smaller.

No ordinary life is without risk. Each day offers new risk choices for all of us and mostly we navigate them safely.

Such is the risk analysis of life in residential care, few tricky decisions can happen instantly. But it is often that spontaneity that defines life and just like Geoff blogged, the danger is that people like his old gold prospector will “continue to make their own arrangements”.

If the demands of governance are such that all spontaneity on decision-making is stifled, people like Billy surely will continue to make their own arrangements.

Now the The Independent Care Group that serves York and North Yorkshire is calling on the regulator to rethink its planned hike in fees or risk damaging social care. Dead right! At West Midlands Care Association we too are furious and are clearly concerned what implications such a move will have on the sector.

An article in the online magazine Care Industry News says the proposed rise in the fee providers have to pay will add thousands to already stretched budgets.

In the case of homecare providers the increase would be 313 per cent phased over two or four years and for care home owners a huge rise, again phased over similar periods.

The group’s Chair, Mike Padgham, is reported as saying that the proposed rise comes at a time when social care was on its knees and was totally unacceptable.

Quote: “Social care is at an all-time low, with £4bn cut from budgets in recent years, fewer and fewer people receiving the care they need and providers going out of existence,” he said.

“Providers are already having to plan for the introduction of the National Living Wage next spring, without enough funding in the sector to pay for it. For this huge rise in the CQC fee to come on top is adding insult to injury and could be the final straw for many providers.”

And sadly it will be the final straw. David Benham, the chief exec. with CQC has made it clear her wants full recovery of costs, thus making the regulator self financing.

Quite how he has the gall to demand this, knowing that full cost recovery for care providers is not happening with local authorities, astounds me.

Cuts in local authority budgets for social care, demand for services on the rise, care homes struggling to make ends meet, more pressure from CQC . . . the picture is bleak even to those of us for whom the glass is half full.

A guy named Richard Pantlin organsied the #CareApps Showcase last month in Leeds, alongside the Association of Directors of Adult Social Services and technology representative body techUK. He recently has tabled some interesting questions and not least: can technology save the care and health sector?

So do we think care apps can replace frontline staff? Err, NO! In fairness neither does he, but he does make a good fist at selling the benefits of how apps could possibly reduce pressures on the sector

Pantlin maintains they can: Improve efficiency of current council processes; build micro eco-systems of friends and family care around individuals in the community; and enable mixed staff groups towards truly integrated, person-centred working.

Good eh? Let’s take a look at a couple of things . . .

One of the key efficiency drivers is a self-service bit of software where people can fill in details online.

A good example of one of these is the online financial assessment offered by Oxford Computer Consultants (OCC), adds Pantlin.

This enables someone requiring care services from the council to complete all their financial details online just as you would do for your online tax return. It then calculates how much you will have to contribute to the cost of your care package.

A somewhat similar example is a tool that enables people to assess whether they are eligible for a deferred payment agreement and if so, how much they would have to pay.

More problematic are online self-assessments of needs since this is a more subjective process benefiting from professional input, the author writes.

He points out “multiple councils are implementing online self-referral or screening tools.” These can signpost members of the public to a wide variety of services depending on their situation if their needs are not likely to meet eligibility thresholds.

But none of these apps are downloadable from an apps store. Rather, they tend to be software hosted by, or on behalf of, a local authority, to be accessed from a laptop, tablet or mobile. They can improve council efficiencies and thereby provide the same or better service to more people at reduced cost – assuming that councils can encourage citizens to “channel shift” to online options.

Developers must assume some digital awareness in their marketplace and efficiencies at a council level do not necessarily result in better care at the sharp end.

Going online needs savvy participators and I don’t believe education levels in the market pool for social care are complete enough to offer this as an entire service option.

There is nothing better that face to face. How many times are we all frustrated by automated call filtering?

Technology might help cut costs, but will never replace the human touch.

Nestling in the pages of The Guardian online I recently found a Jeremy Hughes piece which every person who holds the purse strings on care should read. Hughes opens with the statement that we increasingly expect personalised service.

Spending a weekend in a care home “provided me with a valuable reminder of what providing truly individual care for people with dementia should mean,” he writes, adding . . .

“During my stay, I witnessed a care assistant spend over an hour helping a resident to get nourishment through puréed food when she could neither chew nor swallow.

“There is an art to caring for someone who can no longer communicate verbally and reassuring someone who is anxious and confused.

“One-to-one care was evident day and night. As I watched, I was struck by the fact that you can earn more in a supermarket than a care home. Recently, care home companies have been saying that paying the chancellor’s national living wage could put them out of business. Whether or not this is correct, it’s surely wrong that as a society we cannot afford £9 an hour to look after someone’s wife, husband, mother or father.

“No long-term fix for social care can succeed without addressing how undervalued the people who provide it are.”

I believe there are those who naturally make good carers, but this should never be an excuse not to reward them, or worse, undervalue them.

As Hughes says in his piece it’s time for us, as a society, to accept that the financial limitations we put on the funding of care inflict real pain.

With a real insight, Hughes adds that carers “have been left to pick up the pieces of our broken social care system.”

Indeed it is broken, along with the myriad of promises that were made to fix it. Only the dedication and goodwill of underpaid staff, and indeed some of their employers, allows the system to continue.

But for how long?

What price can we put on personalised care? Recently I read a piece about Starbucks’ £35 million dollar training programme to make their frontline workers “brand evangelists”. Training for managers includes a “theatre experience” and a ‘leadership lab.” Over the top? I think so for a cup of posh coffee, but it highlights just how much this company values personalised service.

Puts the care sector in the shade, doesn’t it! Sadly the care sector cannot compete. Theatre-type interviews by some companies that motivate newcomers with the promise of proper wages and great conditions do exist in the sector. But so much is just ‘spin’. The real scenario is generally one of a perpetual struggle to make business viable enough to pay already depleted wages.

The social care sector could face a shortfall of a million workers in the next 20 years, I’m informed.

The system for adults in England faces a gap of 200,000 care workers by the end of this parliament due to restrictions on immigration and a failure to attract British workers, a report from the charity Independent Age and the International Longevity Centre – UK (ILC-UK), warns.

It adds that this figure will grow unless efforts are made to recruit more overseas staff and retain those already working.

Almost one in five adult social care workers (18.4 per cent) in England were born outside the UK, including 150,000 working in residential care homes.

People from outside the EU account for the largest percentage of migrants working in adult social care – around one in every seven care workers.

And we must also be aware that almost one in 20 (4.8 per cent) of positions in adult social care in England are vacant. That’s nearly twice the rate in the UK’s labour force as a whole.

Simon Bottery, director of policy at Independent Age, is reported as saying: “Without action, there is a real risk of care services worsening as providers fail to fill job vacancies and staff struggle to cope with increasing demand.”

Depressing, or what? But there’s a common chorus in this report we’ve all heard before: The Government must use its influence to invest in social care so it can attract more UK workers, while at the same time exploring new ways of caring for our ageing population in the future.

I’m afraid the tiresome response of the D of H is predictable. Cue keywords “better” and “smarter”.

Frankly, I think all of our care providers have done better than expected and indeed, are pretty smart to still survive in such crippling economic conditions.

What does appear to be an obvious question, however, is this: How are all these extra carers going to be paid? From where will this funding come? No doubt the Government has factored in the numbers (joke).